Provider Demographics
NPI:1467599886
Name:MCGUNNIGLE, LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:MCGUNNIGLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 83
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12485-0083
Mailing Address - Country:US
Mailing Address - Phone:518-589-5060
Mailing Address - Fax:
Practice Address - Street 1:6301 MAIN ST
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12485
Practice Address - Country:US
Practice Address - Phone:518-589-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003935-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2679XALK1Medicare PIN
NYX26792Medicare ID - Type Unspecified
NYX26791Medicare PIN
T52940Medicare UPIN